1. FLUID BALANCE IN CHILDREN Vanessa Lockyer-Stevens Chapter 11

2. Introduction This presentation investigates diarrhoea and vomiting, a major cause of the need for hydration therapy. In conjunction with the book chapter, these slides should enable you to: Identify the population at risk of diarrhoea and vomiting Examine the nurse’s role in the assessment, planning, implementation and evaluation of care for a child with severe diarrhoea and vomiting and their family List support agencies involved in the child’s care following discharge

3. Epidemiology Diarrhoea and vomiting (D&V) in the under 5s is still a leading cause of morbidity and mortality globally. Diarrhoea kills 2.5 million children every year, accounting for approximately 21% of all-cause mortality for children under five years old in developing countries. This equates to ‘one child dying every twelve seconds, or a jumbo jet full of children crashing every 90 minutes’. (Kosek et al 2003).

4. Use the book, or your own sources to answer the following questions within your learning groups: Q. What is diarrhoea and vomiting? Q. What are the common causes? Q. What are the signs and symptoms?

5. Q. Look at the list of issues below. How might each of these affect the treatment you provide to a child with extreme diarrhoea and vomiting, and the advice you give to his family? Physical well-being Psychological well-being Socio-economic circumstances Cognitive development Environment: -Disruption of routine -Effects on parents -Institutional factors -Increased nutrition factors

6. Assessing the Child General impression - Does the child look unwell? Airway, Breathing, Circulation – are they within normal limits for the child’s age? Does the child exhibit gaze aversion? Do they have dry skin, sunken eyes, a positive pinch test? Calculate the severity of dehydration. Have there been less than 3 wet nappies in 24 hours, or less than 2-3 mls/kg for infant; 1-2 mls for young child 4 or ½ ml/kg for older child? How many bouts of diarrhoea and vomiting has the child had?

7. Planning The child needs to be isolated, so where in the ward are they best located? Check room to include oxygen, suction, cot or bed Get: disposable gloves and linen, weighing equipment, stool specimen bottle, cannulation equipment, intravenous and oral fluids Identify: nursing documentation, residency arrangements for parents and who to contact in the first instance (medical staff, play specialists, etc)

8. Implementation Record, report and revaluate neurological state, breathing, pulse, temperature and if required, blood pressure Weigh child to assess percentage of dehydrationAssist with intravenous cannulation. Calculate emergency resuscitation fluids (if required) Calculate replacement fluids Calculate maintenance fluids over 24 hours Accurately record & report all intake: fluid and food Accurately record & report all output: vomit, urine and diarrhoea Communicate plan and procedures to parents at all times Send off stool specimen Pay meticulous attention to child’s skin hygiene particularly buttocks and perineum

9. Evaluation To track recovery, assess whether the child is: More responsive to surroundings? Less irritable, lethargic or distressed? Displaying vital signs within normal range? Hungry and thirsty? Passing more urine? Having fewer episodes of diarrhoea and vomiting? Has sodium levels that are returning to normal?

10. Checklist for Discharge Eating and drinking No further vomiting Seen by Dietician Advice given about reducing the incidence of re- infection and cross infection Information given about open access. Information given about who will follow up and where it will take place Parents happy with the discharge plan

11. After Care – Who Can Help? Open access NHS Direct Heath Visitor Practice Nurse Nurse Practitioner